Abstract
Mental illness is fast becoming a leading cause of global disease burden, yet this aspect of public health remains highly neglected in Nigeria. The public relies on newspapers for diverse information needs and the way newspapers portray mental illness-related issues tends to sway public perception of such ailments. This study examined the level of media attention and prime discursive resources utilized by newspapers to depict mental illness-related issues from 2015 to 2019. Using a qualitative approach and ethnographic design, the study analyzed the manifest contents of three major Nigerian national newspapers selected through a multistage sampling technique. Data collection was done using a coding spreadsheet that reflected relevant content categories and units of analysis. Of the 920 health articles analyzed, only 79 (8.6%) articles discussed mental illness. Also, 84.8% of all mental illness-related articles were tucked in the inside pages of the newspapers and 58.2% of the stories were reported using the conventional straight news. The negative themes of suicide (36.7%) and substance abuse (32.9%) were the prime discursive resources that echoed in many of the analyzed articles. Overall, mental illness-related issues were grossly under-reported by Nigerian newspapers when compared to other health issues, and wrong media depiction of the problem remains a risk factor. Hence, Nigerian newspapers must strive toward setting better agenda that will actuate necessary policy actions from health stakeholders by providing adequate coverage and positive representation of mental illness-related issues.
Key words: mental health, social stigma, psychiatric facilities, public attitude, agenda-setting
Introduction
Mental illness continues to assume more sinister dimensions globally. About 450 million people around the world are currently battling mental disorders, and of this number, 300 million suffer from depression, 60 million are affected by bipolar affective disorders, 23 million are weighed down by schizophrenia and psychoses and about 50 million others contend with dementia (1). Furthermore, Alzheimer's disease and other dementias are listed among the 10 leading causes of global deaths (2), while depression is projected to become a top leading cause of global disease burden by 20303.
Nigeria is among the worst-hit countries by mental illness-related challenges, given that about 40 to 60 million Nigerians suffer various forms of mental ailment (4-6). On the scale of mental illness-induced deaths, Nigeria is rated the fifth most suicide-prone country globally, accounting for about 15,000 out of every recorded 100,000 suicide cases around the world (5). The situation is further exacerbated by general government indifference and wrong public perception of the ailments (5,7-11). This has ultimately promoted social and institutional labeling of people living with mental illness-related challenges, thereby undermining their social support and compromising their opportunity to access treatment, obtain/retain suitable employment and gain acceptable social status (1,4,12-15).
Newspapers present ample opportunities to redirect public attention and engender an appropriate attitude toward mental illness. This is because many people are reliant on newspapers for their health information needs, including mental health-related issues (14,16). There are two major ways newspapers may influence mental illness trends. The first is through the prominence accorded mental illness-related reports. The underlying power of the media to influence individuals' opinions is aptly etched in the assumptions of the Agenda Setting theory which posits that despite the media's limited capacity to decide what the public thinks, they are often reasonably successful at influencing what people should think about by frequently reporting a particular issue in a uniquely prominent style (17). Thus, adequately reported issues of the society with proper placement and timing often tend to enjoy more generous public interest than the less prominent and under-reported ones (18,19).
Similarly, mental illness trends may be influenced by peculiar media portrayals, given the significant positive association between media depiction of issues and people's opinions and/or attitudes toward such issues (20-22). Over the years, wrong newspaper depiction of mental health-related issues has been linked to poor public knowledge and/or wrong perception of the problem by members of society. Previous studies indicate that newspapers play crucial roles in the construction, consolidation, and perpetuation of popular stereotypes and wider societal reactions toward the mentally sick by deploying negative discursive resources to portray the illness (14,23-25). Consequently, our study examines the degree of prominence and type of depiction given to mental illnesses by three leading Nigerian dailies.
Materials and methods
Ethical considerations
The study used secondary data sources mainly from published newspaper articles and involved no human or animal subjects. Hence, formal ethical approval was not sought at the institutional level. However, the researchers abided by the ethical values of integrity and honesty at all stages of the study.
Design and population
The study employed a qualitative approach using an ethnographic design. We conducted a content analysis of Vanguard, Guardian, and Daily Sun newspapers which are some of the major dailies with wide patronage, readership, national outlook, and recognized professionalism across Nigeria. The study population comprised 5,019 issues of the three tabloids published from 1st January 2015 to 31st December 2019. The five years was chosen because mental illness issues featured prominently at the local and international levels within the interlude. For example, in 2017, the WHO carefully chose ‘Depression’ as the central focus of the 2017 global health campaign to mobilize action and direct urgent attention toward the festering state of mental illness-related challenges around the world.
Sample size and sampling technique
To get an appropriate sample, we adopted a composite sampling technique which is widely considered unbiased and superior to random and consecutive day sampling techniques when dealing with newspaper contents (26). When analyzing newspaper health stories, at least six constructed weeks is widely considered most efficient for longitudinal studies within a one to five years time frame (26), hence, we selected ten constructed weeks samples in tandem with scholars' recommendation that one constructed week is as efficient as four for a-six month duration, while two constructed weeks would allow a reliable estimate of stories published in any given newspaper within a year (19,27). Using a four-phase multistage sampling technique, we selected and analyzed 210 issues of the three newspapers within the five years time frame.
Inclusion/exclusion criteria
The main criteria for inclusion or exclusion of any media content were the focus and periods of the reports. Thus, all newspaper reports concerning any aspect of mental illness-related challenges in Nigeria published from 1st January 2015 to 31st December 2019 were potentially included in our analysis, while the ones that were not related to mental illness or published outside the study's time frame were potentially excluded.
Study variables
The study variables were identified and appropriately conceptualized to enhance the coding process. We defined mental illness as the diverse variations of mental health-related challenges, their management, and outcomes. These included issues on mental disorders, substance abuse, suicide, psychologists, psychological features and disorder, insanity, psychiatrists, and psychiatric hospital/medical facility, among others. We measured prominence by assessing how often newspaper articles mentioned mental illness-related issues and the position/placement that such articles were given (be it front page, back page, center spread, or inside pages) (18).
Furthermore, we assessed depiction using the common theme or pattern that reflected across the stories. We operationalized a dominant theme as the group of commonly coherent discursive materials such as words, storylines, illustrations, or images that were used to describe or represent people with mental illness-related challenges and what they do, including the comments, interpretations, and reactions that followed the actions of people believed to be living with mental illness (24). Thus, our main concern was to find out the discursive focus and direction of the stories. A story was adjudged positive if it depicted mental health challenges as curable and amenable to subsisting social order, or negative if it portrayed people with mental illness-related challenges as dangerous, suicidal/homicidal, or similar stigma. Where a story neither portrayed mental health-related issues in a positive nor negative light, it was adjudged neutral (18,19,27).
Coding and inter-coder reliability
We collected the data using a coding spreadsheet designed to reflect the relevant content categories and appropriate units for our study's analysis. The Holsti formula was used to determine the inter-coder reliability of the instrument as widely used in behavioral science studies (18,19,27,28). Two independent coders were assigned the 2017 issues of the three dailies, amounting to about 20% of the entire sample. The test yielded a reliability coefficient of 0.93 for the first research objective and 0.95 for the second, whereas the acceptable benchmark is ≥0.70 (19,27).
Results
Frequency of newspaper reports on mental illness
We found a total of 920 health-related articles published by the three newspapers. Data in Table I show that of this number, only 79 articles, representing 8.6% of all stories discussed mental illness. The remaining 841 (91.4%) health-related stories focused on other issues like HIV/AIDS, Ebola, and cancer. Deductively, only one article bothering on mental health was reported for every dozen health stories published by the three national dailies during the five years.
Prominence of mental illness-related articles in nigerian newspapers
Our result indicated that the analyzed newspapers did not attach much significance to mental illness issues within the studied period. Data presented in Table II indicate that only 7 (8.9%) of the published mental illness-related articles were published on the front page of the analyzed newspapers, 5 (6.3%) on the center spread, while the remaining 67 (84.8%) were positioned on the inside pages. No article on mental health got a space on the back page of any of the dailies. By and large, the straight news format was the leading style used to report mental illness (N=46; 58.2%), followed by features (N=25; 31.7%), opinions and letters to-the-Editor (N=7; 8.9%), and editorials (N=1; 1.3%).
Direction of newspaper reports on mental illness
On the direction of media portrayal, we found an even distribution in the slant of newspaper stories on mental illness-related issues. The data in Table III indicate that while 31 (39%) stories portrayed mental illness-related issues in a positive light, about 30 (38%) of such articles negatively depicted them by emphasizing the perceived dangerous, irresponsible, and homicidal nature of people with mental illness-related challenges. The remaining 18 (23%) articles took a neutral stance on the ailment.
Table I.
Volume of newspaper reports on mental illness.
| Newspaper | The guardian (%) | Daily sun (%) | Vanguard (%) | Total (%) |
|---|---|---|---|---|
| Mental health | 31(9) | 24 (7.8) | 24(9) | 79 (8.6) |
| Other health reports | 315(91) | 284 (92.2) | 242(91) | 841 (91.4) |
Table II.
Placement of mental illness-related articles in Nigerian newspapers.
| Newspaper | The guardian | Daily sun | Vanguard | Total |
|---|---|---|---|---|
| Front page | 03 (42.9%) | 00 | 04 (57.1%) | 07 (100%) |
| Back page | 00 | 00 | 00 | 00 |
| Center spread | 01 (20%) | 03 (60%) | 01 (20%) | 05 (100%) |
| Inside page | 27 (40.3%) | 21 (31.3%) | 19 (28.4%) | 67 (100%) |
Newspaper portrayal of mental illness
Generally, suicide and substance abuse stories dominated the mental illness-related articles published by the three national dailies within the five years duration. Data in Table IV show that the suicide theme was depicted in 29 articles, representing 36.7% of the reported stories, while the substance abuse theme was featured 26 times, accounting for 32.9% of the analyzed stories. Only 9 (11.4%) articles focused on awareness campaigns on mental illness, 6 (7.6%) articles concentrated on cases of dementia/insanity, 3 (3.8%) stories were built around homicide, issues of depression accounted for 4 (5.1%) of the articles, while only 2 (2.5%) of the reported stories focused on mental healthcare facility and framework despite their conspicuous inadequacy.
Discussion
Analyzing data collected from three major Nigerian newspapers, this study seeks to evaluate how mental illness is represented in the Nigerian print media. The outcome showed that mental illness-related issues are grossly under-reported by the Nigerian press. During the investigated period, the three national dailies published only a paltry 79 articles that bothered on mental illness. Conversely, a whopping total of 841 articles on other health-related matters were published by the three newspapers within the same period. Thus, the data showed that for nearly every dozen health stories published by the selected dailies, only one story was likely to be on mental health. Observation during the data collection process showed that the bulk of newspaper coverage on health issues was centered on already well-known diseases like cancer, poliomyelitis, cardiac diseases, Ebola Virus, Celebro Spinal Meningitis, and malaria. Ironically, despite the seemingly low newspaper reports on the growing danger of mental illness, the challenge has remained one of the leading causes of death across the world (1-3). The findings indicate that not much has changed concerning previous worries that mental illness-related issues are being neglected and under-reported by the print media in Nigeria (5,7,8).
Similarly, our examination of newspaper placement of mental illness-related articles indicated that the challenge was not given the much-needed media prominence. We found that 84.8% of the stories were buried in the inside pages of the tabloids, 6.3% were positioned on the center spread, while 8.9% got a space on the front page. No story on mental illness was found on the back page of any of the dailies included in our study. When setting good agenda, editors generally place the most important articles in a conspicuous space for visibility and enhanced readership (18,19,28). No doubt, a newspaper's front page is the most suitable page for media agenda-setting because it is the page that greets the readers and welcomes them into the other pages. In descending order of importance, the front page is succeeded by the back page which is then followed by the center pages and, lastly, the inside pages (18,19,28). Thus, judging by the placement/positioning of the analyzed articles, we argue that newspapers have not successfully set the needed agenda to attract the right policy and mobilize the necessary action to tackle mental illness-related challenges in Nigeria.
Concerning the direction/slant of mental illness-related articles, we observed an appreciable change in the direction of media presentation of mental illness-related issues when compared with previous studies (24,25). In all, 39% of mental illness-related articles leaned toward a positive direction by presenting patients in good light and discussing recovery steps for people with mental illness-related challenges. Even some non-expert articles on the challenge of depression and mental illness-induced suicide also contained messages of hope that are crucial to mental health management. For instance, an article read thus:
You are not carrying the weight of the world on your shoulders alone. We are all coexisting, facing challenges and disruptive distractions together… challenges can be unsettling and no one is immune to their arrival. The best thing to do is to prepare-mentally, emotionally, and physically-for these distractions without losing focus on what truly matters. In essence, if you are breathing and your heartbeat is active, then all is well. There's still hope and potential to guide a favorable outcome in your life.
Table III.
Direction of newspaper reports on mental illness.
| Direction | The guardian (%) | Daily sun (%) | Vanguard (%) | Total (%) |
|---|---|---|---|---|
| Positive | 13 (41.9) | 8 (25.8) | 10 (32.3) | 31(39) |
| Negative | 10 (33.3) | 12(40) | 8 (26.7) | 30(38) |
| Neutral | 8 (44.4) | 4 (22.2) | 6 (33.3) | 18(23) |
Table IV.
Themes/salience in mental illness-related reports.
| Theme | The guardian (%) | Daily sun (%) | Vanguard (%) | Total (%) |
|---|---|---|---|---|
| Suicide | 10 (34.5) | 06 (20.7) | 13 (44.8) | 29(100) |
| Awareness Campaign | 04 (44.4) | 04 (44.4) | 01 (11.1) | 09(100) |
| Substance Abuse | 14 (53.9) | 05 (19.2) | 07(27) | 26(100) |
| Dementia/Insanity | 01 (16.7) | 02 (33.3) | 03(50) | 06(100) |
| Homicide | 01 (33.3) | 02 (66.7) | 00 | 03(100) |
| Depression | 01(25) | 03(75) | 00 | 04(100) |
| Facility/Framework | 00 | 02(100) | 00 | 02(100) |
Nevertheless, 38% of the analyzed newspaper articles also presented mental illness-related articles from a negative perspective, thereby lending credence to previous findings that danger, suspicion, instability, unreliability, irresponsibility, and homicide are the major themes that resonate in mental illness articles (12,23,24). For instance, while reporting on the search efforts for Bayode Ahmed Lawal, who committed suicide by jumping into a lagoon, a newspaper article broadly described the deceased as a ‘psychological patient’ without recourse to medical evidence in support of such bogus conclusion. Besides, the tone of the report also suggested that patients with psychological trauma are erratic and suicidal. A section of the report read thus: ‘He suddenly started acting strangely by rolling on the floor...suddenly jumped up, raced toward the bridge…and jumped in without saying a word. It was gathered he had been through some psychological trauma’. Ironically, the same newspaper that published the stigmatizing article above had earlier published another article in which it expressly quoted the Association of Psychiatrists in Nigeria (ASN) as saying that not all those who commit suicide are mentally ill. Another scenario was a murder case by Mamman Dankarami who was reported to have butchered his three children before committing suicide. Without adequate verification and fact check, a newspaper report alleged that Mamman Dankarami was mentally ill. Oftentimes, such careless and insensitive reports ultimately project people with mental illness-related challenges as suicidal and homicidal, thereby fanning the embers of stereotypes that they already contend with (12,23,24).
With the likely wrong notion that suicides are mainly attributable to mental illness, it was no surprise that negative themes like suicide and substance abuse were the dominant discursive elements that reverberated in most (69.9%) of the mental illness-related articles, while other indices such as mental health awareness, mental health legal framework, and psychiatric facilities received minimal attention, accounting for 13.9% of all articles. Among the articles on suicide, we found that there was not much effort to address the scourge from the mass media angle through proper public enlightenment, indicating a likelihood that suicide-related issues merely enjoyed media attention due to recent statistics placing Nigeria on a high pedestal of the fifth most suicide-prone countries globally (5). Except for a few articles, the stories on suicide merely described the aftermath of the action, adducing them to simplistic causes.
Accordingly, the high number of reports on mental illness-related suicide did not trigger increased newspaper reports on specific mental health awareness campaigns nor did it emphasize the importance of better healthcare facilities and framework for the management of mental illness-related challenges. Only a handful of articles discussed the dearth of mental healthcare facilities, poor healthcare delivery system, and inadequate legal framework, despite the general unavailability of these indices (5,7,9,16). It is instructive to note that, unlike many health challenges, mental illness can only be competently detected by psychiatric experts and other persons skilled in the management of mental health-related challenges. Hence, a lucid discussion of some of the proven simple ways of detecting the challenge may help to reduce its risk.
Limitation
The generalization of our findings could be limited by the adopted sampling method. The headquarters of the three newspapers included in our study are located in Southern Nigeria; hence, there is a chance that most news sources and events on mental illness originated from southern Nigeria. This could, therefore, limit the extension of our findings to all parts of Nigeria, especially the northern region. However, the analyzed newspapers are among Nigeria's leading national dailies. Besides, the major newspapers in the northern axis of Nigeria are affiliated with the media houses in southern Nigeria, and there is hardly any newspaper house in Northern Nigeria that boasts of wide patronage, national outlook, and recognized professionalism across Nigeria like the ones included in our study sample (28).
Conclusions
Despite the limitation stated above, our findings have affirmed the inadequacies of Nigerian newspapers in setting proper agenda for mental illness management, given the under-reportage and low valuation accorded the challenge by the press. Even so, mental illness is still reported from negative slants, with suicide and substance abuse-related themes echoing through most articles on the ailment. Therefore, Nigerian newspapers must set a better agenda that would attract policy actions from stakeholders. Besides, journalists should embark on appropriate professional training to enhance their understanding of mental illness-related issues and how they should be reported.
Acknowledgments
The authors thank the staff of Nnamdi Azikiwe Library, Nsukka, and Enugu Central Library, Enugu for their immense support during the data collection processes.
Funding Statement
Funding: None.
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